Provider Demographics
NPI:1659480671
Name:HARGAN, JAMES KEITH (DMD, MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEITH
Last Name:HARGAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MARY T MEAGHER RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7990
Mailing Address - Country:US
Mailing Address - Phone:270-737-1733
Mailing Address - Fax:270-737-2949
Practice Address - Street 1:1105 MARY T MEAGHER RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7990
Practice Address - Country:US
Practice Address - Phone:270-737-1733
Practice Address - Fax:270-737-2949
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY68841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0749701Medicare ID - Type Unspecified
U84619Medicare UPIN